An Unusual Case of Hyperhemolysis Syndrome and Delayed Hemolytic Transfusion Reaction due to Anti-Jk(a) and Anti-P1 Antibodies.

Background: Hyperhemolysis syndrome (HS) is a severe hemolytic transfusion reaction that can cause hemoglobin and hematocrit levels to drop below pretransfusion levels, leading to severe anemia. HS most commonly occurs in patients with a pre-existing hemoglobinopathy such as sickle cell disease (SCD) or beta-thalassemia. Methods: We report a case of HS, occurring in the absence of hemoglobinopathy, making the diagnosis challenging. The patient reported was also affected by a CIC-rearranged sarcoma. As part of the workup, the patient received a bone marrow biopsy for suspected hemophagocytic lymphohistiocytosis. Results: This provided a rare biopsy specimen to correlate reticulocytopenia with marked erythroid hyperplasia in the marrow, supporting the hypothesis of reticulocyte destruction as a contributing cause of anemia in these patients. This patient had demonstrable alloantibodies to the Jk(a) and P1 antigens as potential triggers for HS. Conclusions: It is vital that a diagnosis of HS be correctly made in these patients with severe anemia, as blood transfusions generally lead to worsening of their conditions.

A case of azathioprine-induced aplastic anemia.

Azathioprine (AZA) is an immunosuppressant that is widely used to treat many disease states including rheumatoid arthritis. We present a patient who was treated with AZA for rheumatoid arthritis and subsequently hospitalized for severe myelosuppression due to acquired aplastic anemia. Upon genetic testing it was found that the patient was thiopurine methyltransferase (TMPT) deficient, a well-documented risk factor for myelosuppression in patients taking azathioprine. We advocate for TPMT and nudix hydrolase 15 (NUDT15) testing prior to initiation of AZA treatment, or close monitoring with a complete blood count post-AZA initiation to avoid these serious side effects.

Intra-urban patterns of neighborhood-level social capital: a pilot study.

Background: Social capital is a construct of interaction and social trust in one's fellow community members. These interactions can provide a safety net for individuals in terms of information, social support, and adherence to social norms. While a number of studies have previously examined the relationship between social capital and health outcomes, few have examined the theparallel relationship of social capital and geographic "place" with respect to health outcomes. Methods: Considering social capital as facilitated by specific structures, we evaluate the relationship between neighborhood-level social capital and disability rates in a major Southern US city. Disability rates were collected through neighborhood-level data via the AmericanCommunity Survey (ACS) and compared to a geocoded map of neighborhood-level social capital measures during spring, 2016. Results: Higher social capital within a neighborhood coincided with lower disability rates in that neighborhood (r=-0.14, P=0.016) when compared to random assortment models. Conclusion: Findings from this research add evidence to the value of the built environment, not only providing resources and shaping choices, but for facilitating important social relationships.